Authors: Christoph H Schick Georg Bischof Alan A E P Cameron Cliff P Connery J Ribas M de Campos Moshe Hashmonai Peter B Licht
Publish Date: 2013/02/08
Volume: 27, Issue: 8, Pages: 3043-3043
Abstract
Sympathetic chain clipping for hyperhidrosis is not a reversible procedure We compliment Dr Loscertales et al 1 for their excellent study a very important addendum to our scientific knowledge of sympathetic ablation for the treatment of primary hyperhidrosis HH Blocking the sympathetic chain by clipping in patients with HH has been used for several years in the belief that if intolerable compensatory hyperhidrosis CHH develops unclipping allows reversal Several clinical studies have been published that report a variable degree of reduction in CHH In some of the “successful” reversals palmar HH did not recur One should bear in mind that the pressure exercised by a clip is reported to be enormous In a study on the required burst pressures for a clip to slip from the vessel on which it was applied values of 593–854 mmHg were needed 2 Removal of a clip by pulling should by itself tear the encompassed tissue Therefore the puzzling aspects of the clinical results that have been published are not the failures but the allegedly successful cases The results of Dr Loscertales et al study further confirm this incompatibility How can we explain the allegedly successful clinical reports The pathophysiology of CHH is absolutely obscure It is possible that unclipping exercises an important placebo effect This is plausible especially for those patients in whom recurrent HH is not observed Is reoperation to remove applied clips justifiable in the light of current knowledge The answer may be negative and patients who are advised to have the clips removed should at least be informed that the basis for the offer is empirical and has no proven scientific ground Further experimental studies are required to prove that in the longterm there is no nerve regrowth through the clipped segment of the sympathetic chain
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